Tethered cord syndrome in adulthood

Area of Science:

• Neurosurgery
• Neurology
• Spinal Cord Disorders

Background:

• Tethered cord syndrome (TCS) in adults presents diagnostic and management challenges.
• The optimal treatment strategy, operative versus nonoperative, for adult TCS remains controversial.
• A comparative study is essential to guide clinical decision-making.

Purpose of the Study:

• To analyze the outcomes of operative and nonoperative management in adult patients with tethered cord syndrome.
• To identify common clinical presentations and etiologies of TCS in adulthood.
• To evaluate patient adherence to treatment recommendations.

Main Methods:

• Retrospective chart analysis of 22 adult patients diagnosed with caudal spinal cord tethering.
• Data collection included patient demographics, clinical presentation, diagnosis, and treatment received.
• Outcomes were assessed by comparing preoperative and postoperative neurologic status.

Main Results:

• The most frequent complaints included back pain (68.1%), bladder dysfunction (36.3%), and leg pain (31.8%).
• Tight filum terminale was the most common cause of tethering (21 patients).
• Twelve patients refused surgery despite significant neurological deficits; 8 of 10 surgical patients underwent detethering with no infectious complications.

Conclusions:

• A significant number of adult patients with TCS refuse surgical intervention, even with severe symptoms.
• Comprehensive patient and family counseling regarding surgical risks and benefits is crucial.
• Larger, prospective randomized trials are necessary to definitively establish the efficacy of operative versus nonoperative management for adult TCS.